Anesthesia — Core of Discipline

C19 Assessing and providing comprehensive multi-modal management for patients with complex acute pain

- This EPA includes the assessment and management of patients with pain in a variety of settings, including the immediate post operative period, the inpatient surgical ward, patients with trauma not requiring surgery, or those with acute medical conditions.
- This EPA focuses on the management of complex patients with various co- morbidities which may complicate pain management; examples include patients with acute pain who have pre-existing chronic non-cancer or cancer pain; patients with opioid tolerance, including those with a substance use disorder and those on opioid agonist therapy such as methadone or buprenorphine; patients in a “pain crisis”; geriatric patients with cognitive impairment; or patients with significant co- morbidities interacting with pain management such as obstructive sleep apnea or severe pulmonary disease.
- This EPA includes performing any technical procedures related to acute pain management, and the management of analgesia related side effects and complications.
- This EPA may be observed in adult, elderly and pediatric patients.

Form

F1: Observation

Milestones

• ME 1.3. Apply knowledge of the anatomy, physiology and pharmacology in the development of a pain management strategy

• ME 2.4. Diagnose and manage the complications of various acute pain management strategies

• ME 2.2. Elicit a history, perform a physical exam and select appropriate investigations, and interpret their results for the purpose of diagnosis and management of a patient with acute pain

• ME 2.2. Develop a differential diagnosis for pain, with appropriate consideration of rare but serious conditions.

• ME 3.1. Determine the most appropriate procedures or therapies for the purpose of management of acute pain

• ME 3.4. Perform the pain management and all related technical procedures in a skilful and safe manner, adapting to unanticipated findings or changing clinical circumstances

• ME 4.1. Implement a patient-centred care plan that supports ongoing care, follow-up on investigations, response to treatment, and further consultation

• COM 2.2. Manage the flow of challenging patient encounters, including those with angry, anxious or distressed individuals

• COM 5.1. Document clinical encounters to adequately convey clinical reasoning and the rationale for decisions

• COL 1.3. Communicate effectively with physicians and other colleagues in the health care professions

• ME 2.2. Identify patients who may be at risk of chronic post-surgical pain or substance use disorder, and intervene appropriately

• L 4.2. Manage time and priorities efficiently to provide safe, timely care

Context Variables

No context variables defined.

Requirements

• Direct observation or case review and debrief by supervisor
• Use Form 1 or local alternative. Form collects information on:
• Type of issue: initial management; follow
• up care
• Patient category: post
• operative; trauma; medical
• Complications of pain management: yes; no
• If yes indicate type of complication [text box]:
• Describe complexity of case [text box]:
• Collect observations from a large breadth of training experiences and issues, including complications of pain management, with the expectations not all will be achieved, with a minimum of 6 observations of achievement